HIV Screening in a Rural Antenatal Clinic

Introduction

The acquired immunodeficiency syndrome (AIDS) epidemic has proved to be a major stumbling block in achieving health improvements in many regions. In the developing world, it is estimated that 2.5 million HIV-infected women give birth each year1 with the risk of maternal-child transmission of the infection a real concern. The aims of the current study were:

1. Assess the prevalence of HIV among pregnant women attending a private nursing home in the rural town of Akluj, India (population 40,000); and
2. Identify HIV-infected women with a view to providing medical termination of pregnancy where appropriate.

Patients and Procedures

Seven hundred and eighty antenatal cases were tested for HIV (using INSTI and TRIDOT) between January 1, 1998 and June 30, 1998 when they came for routine antenatal check-up. At the same time, other routine investigations such as haemaglobin measurement and blood typing were completed. Testing HIV-positive provoked confirmation of status using the Western Blot method and testing of the women's husbands.

Results

Of the 780 women screened, 20 (2.56%) tested HIV-positive. Each of these women's husbands also tested HIV-positive: 7 (35%) who worked locally and 13 (65%) who worked at distant locations. The greatest proportion of HIV-positive patients were in the 21-23 year age group (see table 1).

Seven HIV-positive cases underwent medical termination of pregnancy before 8 weeks gestation while all babies delivered to HIV-positive mothers were subsequently found to be HIV-positive.

Conclusion

This study suggests a high incidence of HIV infection in the rural region surveyed. [Editor's note: Maharashtra is indeed one of the high prevalence states for HIV infection; the figure of 2.56% in this rural population matches that of the urban population in this region (see page 17).]

Reference

1. Graham WJ, Newell ML. Seizing the opportunity: collaborative initiatives to reduce HIV and maternal mortality. Lancet 1999;353:836-839.

This brief report, the first in the Clinical Communique series, is a descriptive study documenting the incidence of human immuno-deficiency virus (HIV) in a group of rural pregnant patients. The author introduced routine HIV screening for all antenatal cases attending a private nursing home in response to World AIDS Day, 1998.